Clinical guidelines for the diagnosis and treatment of pulmonary hypertension


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Abstract

Pulmonary hypertension (PH) is a group of diseases characterized by progressive increases in pulmonary vascular resistance and pulmonary artery pressure, which results in right ventricular heart failure and sudden death. Based on the current version of the guidelines for PH diagnosis and treatment, adopted by the experts of the European Society of Cardiology and the European Respiratory Society in 2009, and on the data of Russian and foreign clinical trials, the Russian experts elaborated clinical guidelines for PH in 2013. The latter consider the current classifications of PH, the specific features of its pathogenesis, and its diagnostic algorithm. The section dealing with drugs for maintenance therapy discusses data on the use of oral anticoagulants, diuretics, cardiac glycosides, and oxygen therapy. PH-specific therapy includes calcium antagonists, prostanoids, endothelin receptor antagonists, and phosphodiesterase type 5 inhibitors. Surgical procedures for PH involve atrial septostomy, thromboendartectomy, and lung or heart-lung transplantation. A treatment algorithm is proposed for PH patients. The current medicinal approaches using specific therapy agents and their combinations offer new promises for the effective treatment of patients with PH and improve its prognosis.

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Клинические рекомендации по диагностике и лечению легочной гипертонии. - Аннотация Легочная гипертония (ЛГ) - это группа заболеваний, характеризующихся прогрессирующим повышением легочного сосудистого сопротивления и давления в легочной артерии, которое приводит к развитию правожелудочковой сердечной недостаточности и преждевременной смерти пациентов. На основании современной версии рекомендаций по диагностике и лечению ЛГ, принятой экспертами Европейского общества кардиологов и Европейского респираторного общества в 2009 г., клинических данных национальных и зарубежных исследований в 2013 г. российскими экспертами разработаны клинические рекомендации по ЛГ. В них рассматриваются современные классификации ЛГ, особенности патогенеза, алгоритма диагностики ЛГ. В разделе, посвященном средствам поддерживающей терапии, обсуждаются данные о применении пероральных антикоагулянтов, диуретиков, сердечных гликозидов, оксигенотерапии. Специфическая терапия легочной артериальной гипертонии (ЛАГ) включает антагонисты кальция, простаноиды, антагонисты рецепторов эндотелина, ингибиторы фосфодиэстеразы 5-го типа. Среди методов хирургического лечения ЛГ представлены предсердная септостомия, тромбэндартерэктомия и трансплантация легких или комплекса сердце-легкие. Предлагается алгоритм лечения больных ЛАГ. Современные медикаментозные подходы с использованием препаратов специфической терапии и их комбинаций открывают новые перспективы эффективного лечения больных ЛАГ, улучшают их прогноз.
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